The thrombophilic effect of combination hormonal methods is produced by the estrogen component. Progestin-only contraceptives (injectable progestin, etonogestrel implant, POPs, levonorgestrel releasing IUDs) are more appropriate for women with these conditions, and potentially as well for those with significant coronary vascular disease risk factors. Combination hormonal contraceptives (oral, transdermal or vaginal) are not recommended for women with documented history of unexplained VTE or VTE associated with pregnancy or exogenous estrogen use, unless they are taking anticoagulants. The copper T380A IUD contains no hormones and therefore is an appropriate contraceptive option for these women. Barrier methods are also acceptable, however they have less contraceptive efficacy. At the present time screening for hypercoaguable states is not routinely recommended in low risk women (with a personal history or strong family history of VTE or PE) before initiating a combination hormonal contraceptive. Diabetes Combination hormonal contraception does not adversely affect metabolic control or increase vascular disease or CVD risk in women with type 1 or type 2 diabetes mellitus without vascular disease. In diabetic women with vascular involvement, combination hormonal contraceptive methods are contraindicated. ACOG recommends combination hormonal contraceptives should be limited to non-smoking otherwise healthy women younger than age 35 years with no evidence of hypertension, nephropathy or retinopathy. For women with diabetes without vascular disease or hypertension, the use of copper IUDs, levonorgestrel IUDs, or progestin-only contraceptive methods is not contraindicated. For women with diabetes with vascular disease or hypertension, the use of copper IUDs or progestinonly contraceptive methods is acceptable. DMPA has been associated with increased fasting blood sugar levels in women with well-controlled diabetes. However the clinical significance of this is uncertain. Combination hormonal contraceptive use does not precipitate type 2 diabetes even in women with a history of gestational diabetes.
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